title: In vivo microscopic features of nodular melanomas: dermoscopy, confocal microscopy, and histopathologic correlates.
abstract: OBJECTIVE
  To characterize nodular melanoma (NM) using dermoscopy, in vivo reflectance-mode confocal microscopy, and histopathologic analysis.
  
  
  METHODS
  Consecutive pure NMs and superficial spreading melanomas (SSMs) with nodular or blue areas were studied using dermoscopy and confocal microscopy, and a correlation with histopathologic findings was performed.
  
  
  METHODS
  Ten NMs, 10 SSMs with a nodular area, and 10 SSMs with a blue palpable but not yet nodular area.
  
  
  METHODS
  Confocal differences within the nodular component between pure NMs and SSMs with a nodular area, hypothesizing different biological behaviors.
  
  
  RESULTS
  Whereas NMs had predominantly nonspecific global dermoscopic patterns, SSMs exhibited a multicomponent pattern and higher dermoscopic scores. Globules, blue-white veil, atypical vessels, and structureless areas were frequent in NMs and in nodular areas from SSMs. At confocal microscopy, NMs exhibited few pagetoid cells within a typical epidermal architecture in the superficial layers in most cases, differing from SSMs frequently characterized by epidermal disarrangement and pagetoid infiltration. At the dermoepidermal junction, dermal papillae were rarely seen in nodular areas both from NMs and from SSMs, frequently substituted by nonaggregated atypical cells distributed in sheetlike structures. In the upper dermis, all groups exhibited plump bright cells, dense dishomogeneous cell clusters, and atypical nucleated cells, whereas cerebriform clusters were characteristic of NMs. Conclusion Distinctive dermoscopic and confocal features seen in NMs compared with SSMs are helpful in making the diagnosis and suggest different biological behavior.
authors.affiliation: Department of Dermatology, Hospital Clinic, Barcelona, 170 Villarroel, 08036 Barcelona, Spain. ssegura@imas.imim.es
authors.forename: Sonia
authors.initials: S
authors.lastname: Segura
authors.forename: Giovanni
authors.initials: G
authors.lastname: Pellacani
authors.forename: Susana
authors.initials: S
authors.lastname: Puig
authors.forename: Caterina
authors.initials: C
authors.lastname: Longo
authors.forename: Sara
authors.initials: S
authors.lastname: Bassoli
authors.forename: Pascale
authors.initials: P
authors.lastname: Guitera
authors.forename: Josep
authors.initials: J
authors.lastname: Palou
authors.forename: Scott
authors.initials: S
authors.lastname: Menzies
authors.forename: Stefania
authors.initials: S
authors.lastname: Seidenari
authors.forename: Josep
authors.initials: J
authors.lastname: Malvehy
mesh_terms: D000328:Adult; D000368:Aged; D001707:Biopsy, Needle; D015331:Cohort Studies; D046169:Dermoscopy; D004817:Epidermis / Q000473:pathology* / Q000648:ultrastructure*; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008545:Melanoma / Q000175:diagnosis* / Q000473:pathology; D018613:Microscopy, Confocal; D008875:Middle Aged; D009367:Neoplasm Staging; D011336:Probability; D015203:Reproducibility of Results; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012878:Skin Neoplasms / Q000175:diagnosis* / Q000473:pathology